| NPI | 1780202614 |
|---|---|
| Former Name | KAYLA J STANNARD |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 050091) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2020-07-07 |
| Last Update Date | 2024-05-20 |